Evaluation of Current Practice of Antibiotic Use and Clinical Outcomes of Community-Acquired Pneumonia Patients with Type 2 Diabetes Mellitus in Indonesia

Abstract

Impaired immunity in diabetes mellitus (DM) causes reduced lung function, which increases the incidence of various types of infections, including community-acquired pneumonia (CAP). The main principle of CAP therapy is the administration of antibiotics. This study aims to assess the appropriate use of antibiotics according to existing clinical practice guidelines using the Gyssen algorithm, and to determine its effect on clinical outcomest in hospitalized patients. It is an observational study with a retrospective cohort design and total sampling technique. The research was conducted at Dr. Cipto Mangunkusumo Hospital Jakarta, with the research subjects being 98 hospitalized CAP patients with type 2 DM (T2DM) over the period January 2018 - December 2019. The collection of data on patient characteristics and clinical outcomes was made through patient medical records. 28.6% of the subjects were in the severe category of CAP. The results of the evaluation using the Gyssen algorithm showed that 59.2% of the subjects receive the appropriate antibiotics, while 40.8%  receive non appropriate antibiotics. The clinical outcomes in the group receiving appropriate antibiotics (70.7%) was significantly higher than the non-appropriate group (42.5%). The results of the multivariate analysis show that the group receiving appropriate antibiotics experienced 2.7 times greater clinical outcomes (RR 2.683, 95% CI: 1.102-6.592), after controlling for the degree of CAP and the onset of antibiotic administration. The use of appropriate antibiotics in CAP patients with T2DM significantly enhanced clinical outcomes.